When we first began welcoming students back last fall, none of us really knew what to expect -- nor could we anticipate what additional obstacles might remain ahead. Some approaches were more successful than others. But one thing we all learned is how critical flexibility, collaboration, creativity and out-of-the-box solutions are when trying to manage multilayered safety risks.
Here in Charlottesville, we took to the sewers. Literally.
If necessity is the mother of invention, figuring out how to stay safe in a pandemic may be the mother of all necessities. It's what led us to pivot from our existing research -- tracking antibiotic-resistant bacteria through wastewater testing -- to testing sewage samples
for RNA remnants of the coronavirus collected from the waste of infected building occupants, enabling us to quickly locate and address Covid-19 infections on campus.
Our research remains critical to keeping the University of Virginia open for students.
In September, we began a program in which we monitor many dorms housing thousands of students and look for early signals of new potential positive cases within the building. Dorm wastewater data is combined with other information to identify asymptomatic infected residents early and trigger additional testing of all dorm residents, then isolate them to prevent further spread.
During the fall semester, we had several instances in which the wastewater surveillance pinpointed a small number of infected students in a dorm before a single student reported symptoms or tested positive via other surveillance, triggering isolation of that cohort of students and likely preventing further transmission.
We've learned three essential lessons in this, frankly, dirty work.
The first is that cross-disciplinary collaboration is key to rapid innovation -- the existing professional relationship between the two of us enabled us to rapidly repurpose existing technology as a promising new solution.
We make for an unlikely pair in academia; as a doctor specializing in infectious diseases and an environmental engineering professor, we represent two fields that rarely work hand-in-hand, and we were fortunate to have recognized the benefits of teaming up.
Second, wastewater sampling is cost-effective for institutions. It can save time, money and resources because widespread individual testing becomes unnecessary with the use of this early detection system.
Costs of frequent individual swab testing can potentially reach tens of thousands of dollars, while, comparatively, a wastewater-monitoring solution like ours would cost tens of hundreds. For example, if a test costs $20, and if there are 100 people in each building, testing all 100 people in each of 18 student buildings on campus would be $36,000 -- daily. With strategic testing, the cost would be $2,000 occasionally -- only if a positive is detected in the wastewater and that building's occupants need swab tests.
Even if students are currently only tested a few times per week, wastewater monitoring -- combined with strategic swab testing in a building population administered only when remnants of Covid-19 RNA are present in wastewater -- would cut costs drastically by reducing the frequency of testing.
The wastewater solution also involves a smaller burden on the residents, uses fewer personnel and testing resources than testing individuals daily, and requires a relatively small initial investment of about $2,000 for the monitoring equipment, which also costs little to maintain.
Finally, there's a prime opportunity to repurpose the wastewater testing technology that is done in the university setting by expanding its use to protect people living in other types of high-density living conditions.
Until new vaccines become widely available, expanding building-level wastewater detection systems beyond the university sector could prove to be a game changer that saves lives in both the near and long term. We know that the end of Covid-19 is not immediate and another pandemic in our lifetime is certainly possible.
With a highly contagious respiratory infection like Covid-19, vulnerable populations that cohabitate could stand to benefit the most, such as people living in long-term care facilities. Many nursing homes require routine testing of residents once or twice a week, depending on the community prevalence
in an attempt to capture early infection and prevent widespread transmission.
Even with many nursing homes fully vaccinating their residents, implementing wastewater screening now will help determine the efficacy of vaccines in group settings, including understanding whether the vaccine protects against new variants of Covid-19, and will also enable these facilities to monitor for the emergence of other infectious diseases.
The value of wastewater detection systems extends beyond the current crisis and even beyond nursing homes. Integrating wastewater detection systems into residential facilities on a broader scale could add capacity to our struggling public health systems by enabling the detection of diseases at the hyperlocal level before they spread further.
The data could also contribute to other vital public health research, such as an archive of sewage samples
that could be used to document viruses and how they change over time. This type of data could help scientists combat new viruses faster and help answer questions experts may not be able to fathom yet.
That said, wastewater testing is not an entirely simple endeavor; staff would need to be trained on safely collecting the samples, and institutions without in-house labs would need to send samples to external labs for testing.
However, institutions like UVA that have successfully created these systems are ready and able to provide training and assistance to help other institutions set up similar systems. And, in the long run, wastewater surveillance systems would benefit institutions and our nation's public health system by ensuring that our vaccine rollout is working and providing an additional safeguard to help monitor for future outbreaks of other contagious diseases.
Public funding should support the expansion of wastewater detection systems, as it did at our university, particularly in institutions that serve vulnerable populations where people cohabitate, such as hospitals, public universities such as UVA, military bases and jails; nongovernmental institutions like nursing homes and private schools could also reap the benefits of investing in this system.
Private industry investment would also be needed to advance further technological breakthroughs. The wastewater testing technology requires some mechanical improvements to make it work on a larger scale -- something that we hope in the future to accomplish working in tandem with private manufacturers (though we have no partnerships at the moment).
These improvements, such as automating the sampling process, will make the testing technology better equipped to serve facilities that need them.
Let's take the opportunity to build on what we learned during the pandemic: How to rapidly transform a fledgling prototype into an unconventional, campuswide solution. Investing in wastewater detection has made a big difference at our university during an unprecedented crisis. Unusual solutions can be a source of success for combating emerging diseases now -- and for decades to come.